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General NPI Number Information
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NPI Number | 1023620648
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Entity Type | Individual
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Provider Name | BLANCA ESTELA MALDONADO OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 671 E COOLEY DR STE 102
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City | COLTON
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State | CA
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Zip | 92324-4014
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Country | US
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Telephone | 909-261-0483
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Fax |
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Provider Business Mailing Address
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Address Line | 1661 DAVIDSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-1708
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Country | US
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Telephone | 909-261-0483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | SLD5882
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License Number State | CA
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